| NPI | 1679078265 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150513) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301503564) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-01-12 |